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Pharmacy Benefit Management Services in the US Procurement Price, Data and Insights
A pharmacy benefit management (PBM) provider is a third-party company that manages the sale and distribution of government and employer-sponsored prescription drugs. In addition to processing prescription drug claims, PBM firms develop and maintain formulary. PBM providers leverage their size to contract with pharmacies and negotiate discounts and rebates with pharmaceutical manufacturers. This report is intended for buyers with fully funded insurance and is not tailored to self-insured employers. Common buyers of PBM services include health insurance carriers, pharmacies, and healthcare facilities.
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What’s included in this market coverage
IBISWorld's research coverage on the Pharmacy Benefit Management Services procurement and pricing environment in the United States includes market dynamics, buyer power scores, supply chain vendors with pricing trends and forecasts.
About this Market
What’s this procurement report about?
This procurement coverage of the Pharmacy Benefit Management Services market in the United States includes Drug Formula Development & Maintenance and Prescription Drug Claims Processing. Standard coding in this coverage includes ISIC-6512-Non-life insurance, NACE-65.12-Non-Life Insurance, NAICS-524114-Direct Health and Medical Insurance Carriers and UNSPSC-85121902-Commercial pharmaceutical services.
What common market terminology is included?
Common market terminology included in the Pharmacy Benefit Management Services procurement coverage includes Maximum Allowable Cost (MAC) (The upper price limit that a plan will charge the buyer for a specific drug.), Average Wholesale Price (AWP) (A reference price point that PBMs use to determine drug discount rates. AWPs are not always accurate estimates of what buyers pay for a given drug.), Managed Care Organization (A vertically integrated healthcare service organization that aims to reduce costs for patients through economies of scale and discount partnerships.), Capitation (A fixed amount of money that is paid for a product or service regardless of healthcare type.), Formulary (A list of preapproved drugs that have set MAC limits; also called a MAC list.), Direct & Indirect Remuneration (DIR) Fees (A collection of various fees, including network participation fees, reconciliation fees, and other service charges, that PBMs require buyers to pay in addition to administrative fees.), Blockchain (A chain of blocks made up of digital pieces of information that are stored in a public digital ledger that functions similarly to a database.) and Internet of Things (IoT) (A network of objects that are connected through the internet to be able to collect and exchange data.).
What companies are included as top suppliers?
The top companies covered in the Pharmacy Benefit Management Services procurement report as suppliers are Rxadvance Corp, Prime therapeutics Llc, Medimpact Healthcare Systems Inc., Rite Aid Corp and Humana Inc..
Opportunity Assessment
What’s included in the Opportunity Assessment chapter?
The Opportunity Assessment chapter provides a comprehensive market analysis of the Pharmacy Benefit Management Services market in the United States category, including buyer power scoring, market pricing trends, vendor landscape, cost structure, and strategic negotiation levers.
The market pricing trends include the Market Price (2026) per transaction, a five year price forecast and a supply chain risk score. Vendor coverage includes a market share and cost structure breakdown.
Analysis includes a comprehensive SWOT analysis of and recent developments impacting the Pharmacy Benefit Management Services market environment.
Buyer Power Score
What’s included in the Buyer Power Score chapter?
The Buyer Power Score chapter assesses key components impacting Pharmacy Benefit Management Services procurement including the recent price trend, forecast price trend, availability of substitutes, switching costs, product specialization, average vendor risk, market share concentration, supply chain risk, price driver volatility and recent price volatility.
These components generate a Buyer Power Score that ranges from -5 (strongly favoring sellers) to +5 (strongly favoring buyers) plus a recommended strategy for procurement specialists.
Price Environment
What’s included in the Price Environment chapter?
The Price Environment chapter covers detailed pricing analysis and datasets on Pharmacy Benefit Management Services market environment. This includes insights into market pricing Market Price (2026), price forecasts, volatility, specialization, substitutes and switching costs.
Datasets in the Price Environment chapter include vendor cost structure, breakdowns of wage rates by geography and specialty, key external economic and labor drivers impacting the market and market pricing models.
Supply Chain & Vendors
What’s included in the Supply Chain & Vendors chapter?
The Supply Chain & Vendors chapter covers the concentration, risk and diversity of the Pharmacy Benefit Management Services market. This includes datasets on the market’s top suppliers, detailed analysis on the key sourcing risks and supply chain dynamics, with environmental, social and governance (ESG) considerations and scores.
Business Requirements
What’s included in the Business Requirements chapter?
The Business Requirements chapter covers vendor relationships, qualifications, service level agreements and key performance indicators. These inputs provide insight into the planning process through the buying lead time, vendor relationship and vendor qualifications. The sourcing process include key RFP elements like an organizational overview, project budget, selection criteria, project schedule, proposal format, inventory control, cost containment, regulation, quality control, distribution and key contract clauses.
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Frequently Asked Questions
What is the current market price for Pharmacy Benefit Management Services?
The 2026 benchmark market price for Pharmacy Benefit Management Services is $4.89 per transaction. Prices have increased at a CAGR of 1.4 from 2023-26.
Who are the top vendors in the Pharmacy Benefit Management Services market?
The top vendors in the Pharmacy Benefit Management Services market include Rxadvance Corp, Prime therapeutics Llc, Medimpact Healthcare Systems Inc., Rite Aid Corp and Humana Inc..
What industries supply the Pharmacy Benefit Management Services market?
The top industries supplying the Pharmacy Benefit Management Services market are Brand Name Pharmaceutical Manufacturing in the US, Chemical Product Manufacturing in the US, Computer Manufacturing in the US, Circuit Board & Electronic Component Manufacturing in the US, Computer & Packaged Software Wholesaling in the US and Software Publishing in the US.
What is the supply chain risk for Pharmacy Benefit Management Services?
Extreme market share concentration limits buyer negotiation power. The PBM services market has a very high degree of market share concentration, with the top three suppliers, Cigna, CVS Health Corporation, and UnitedHealth Group, controlling roughly 80% of total revenue. For buyers, this structure means far less negotiation leverage and limited options for supplier switching, as these dominant vendors set market standards. Procurement teams should prepare for potentially higher pricing, reduced flexibility in contract terms, and higher switching costs. Buyers should seek to leverage competition wherever possible to limit the effects of leading vendors' market dominance, such as including smaller competitors in bidding processes and regular market price benchmarking.
What factors affect the price of Pharmacy Benefit Management Services?
Channel type significantly affects pricing in pharmacy benefit management as it determines the negotiation leverage PBMs have with pharmacies and drug manufacturers. For example, retail pharmacies face higher operating costs and cannot access the same economies of scale as mail-order pharmacies.
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